Nominations for the Neurological Alliance Board of Trustees

To be elected at the Annual General Meeting on Wednesday 22 November 2017

Name of nominee
Job title
Organisation name
Organisation address
Tel
Mobile
Email
Pen profile (200 words maximum)
This should give brief details about your background, reasons for standing and what skills and knowledge you can bring to the Alliance's work. Please also include how your work so far fits with the ‘Main duties and responsibilities’ and ‘Job specification’ outlined above.
For Trustees standing for re-election, your pen profile should specify your contributions to the Board.

For existing Trustees

How many Board of Trustees meetings have you attended in the last year?

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I certify that I:

  • Have no unspent conviction for an offence involving deception or dishonesty;
  • Am not undischarged bankrupt;
  • Have not been removed from Trusteeship of a charity by the Court or the Commissioners for misconduct or mismanagement; and
  • Am not under a disqualification order under the Company Directors Disqualification Act 1986.
  • Am over the age of 18
  • Am willing to be re/appointed as a Trustee
  • Am representing is a full or affiliate member of the Alliance
  • Am willing to stand for election to the Board of Trustees

Date: ……………………..... / Name: …………………………………......
Position: …………………… / Signature: …………………………………......
AUTHORISATION OF NOMINATION
We require authorisation by the head of your organisation or appropriate line manager that you are your organisation’s nominated candidate.
I am authorised by (organisation name)
…………………………………......
to propose the candidature (nominee's name and organisation)
…………………………………......
and will advise the Alliance immediately should they cease to be associated with our organisation.
I declare that my organisation is a full or affiliate member of the Alliance, and have paid the current subscription for 2017-18.
Date: ……………………..... / Name: …………………………………......
Position: …………………… / Signature: …………………………………......

You may reply electronically if you wish, using electronic signatures. Nominations must reach the Company Secretary or TheNeurological Alliance, c./o. The British Polio Fellowship, The Xchange, Wilmington Close, Watford, Hertfordshire, WD18 0FQ betweenWednesday18 October and12pm onWednesday1November 2017.

Any forms received after this date will not be considered in the ballot.

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